经皮椎体成形术和经皮椎体后凸成形术治疗骨质疏松性椎体压缩骨折

Percutaneous vertebroplasty and percutanous kyphoplasty for osteoporotic vertebral compression fractures

目的:观察经皮椎体成形术(percutaneous vertebroplasty,PVP)和经皮椎体后凸成形术(percutanous kyphoplasty,PKP)治疗骨质疏松性椎体压缩骨折的疗效。方法:2007年10月～2009年4月收治骨质疏松性椎体压缩骨折患者106例,其中61例82个椎体接受PVP治疗,男21例29个椎体,女40例53个椎体,年龄65～96岁,平均78.3岁;45例55个椎体接受PKP治疗,男17例21个椎体,女28例34个椎体,年龄68～90岁,平均77.1岁。术前及术后1d进行疼痛视觉类比评分(VAS),测量伤椎高度,随访伤椎高度丢失情况,记录骨水泥渗漏及随访期间邻近椎体骨折情况。结果:PVP组术前和术后1d VAS分别为6.7±1.4分和2.1±0.7分,PKP组分别为6.9±1.2分和2.2±0.9分,每组术后VAS与术前比较有统计学差异(P<0.05),同时间点组间比较无统计学差异(P>0.05)。PVP组55例、PKP组41例获得随访,随访时间为12～36个月,平均18个月。PVP组和PKP组术后伤椎高度分别较术前增加2.4±1.8mm和9.2±2.2mm,术后12个月随访伤椎高度分别丢失0.8±0.5mm和1.9±0.8mm,两组比较有统计学差异(P<0.05)。PVP组术中骨水泥渗漏28例33个椎体,PKP组15例17个椎体,PKP组骨水泥渗漏率明显低于PVP组(P<0.05)。随访期间PVP组发生相邻椎体骨折9例,PKP组6例,两组相邻椎体骨折发生率无统计学差异(P>0.05)。结论:PVP和PKP治疗骨质疏松性椎体压缩骨折的止痛效果均较好;PKP的复位效果优于PVP,较少发生骨水泥渗漏,但术后椎体高度再次丢失较明显;两者术后相邻椎体骨折发生率无明显差异。

Objetives：To observe the clinical outcomes of percutaneous vertebroplasty（PVP） and percutanous kyphoplasty（PKP） for osteoporotic vertebral compression fractures（OVCF）.Method：106 patients underwent PKP or PVP from October 2007 to April 2009.61 cases（82 vertebrae） had PVP which included 21 males（29 vertebrae） and 40 females（53 vertebrae）,with the average age of 78.3 years（range,65 to 96 years）,while 45 cases（55 vertebrae） had PKP which included 17 males（21 vertebrae） and 28 females（34 vertebrae）,with the average age of 77.1 years（range,68 years to 90 years）.VAS and height of the injured vertebra were evaluated preoperatively and 1 day postoperatively seperately.The PMMA leakage were recorded and the vertebrae height loss and new fracture of adjacent vertebra were evaluated during the follow-up.Result：Preoperative and postoperative VAS were 6.7±1.4 and 2.1±0.7 in PVP group and 6.9±1.2 and 2.2±0.9 in PKP group respectively,which showed significant difference（P0.05）,but no inter-group difference were noted（P0.05）.55 cases in PVP group and 41 cases in PKP group were followed up for an average of 18 months（range,12 months to 36 months）.The height of injured vertebra increased 2.4±1.8mm and 9.2±2.2mm for PVP and PKP group respectively,while the height loss in 12 months after operation was 0.8±0.5mm and 1.9±0.8mm,which showed difference between PKP and PVP group（P0.05）.28 cases in PVP group and 15 cases in PKP group suffered PMMA leakage,which showed difference between two groups（P0.05）.15 cases were complicated with adjacent vertebra fracture during follow-up.Of them,9 were in PVP and 6 in PKP group,which showed no difference between two groups（P0.05）.Conclusion：PVP and PKP both are reliable in pain relief,while PKP is better than PVP due to its good reduction and less bone cement leakage,however its postoperative loss of height is remarkable.No adjacent vertebra fracture related difference are noted for each protocol.